Physical Therapy to Improve Mobility Following Surgery for Multiple Ligament Knee Injury

For a physical therapy student completing a clinical internship, one quickly learns that not all patients present as perfectly as they do in the textbooks. This case report highlights the clinical decision making to navigate such a patient and the various interventions used to reduce pain, increase range of motion and help the patient return to functional activities following a complex knee injury. The purpose of this study is to map the clinical decision-making process from a student physical therapist’s perspective in managing a 21-year-old male with multiple knee ligament injuries to help improve knee mobility.https://soar.usa.edu/casmfall2018/1004/thumbnail.jp

Comparing Open-Ended Choice Experiments and Experimental Auctions: An Application to Golden Rice

We use two different experimental valuation methods to estimate consumer demand for genetically-modified golden rice. The first is an open-ended choice experiment (OECE) where participants name the quantities of golden rice and conventional rice demanded at each of several price combinations, one of which will be randomly chosen as binding. This allows us to estimate market demand by aggregating demand across participants. This estimate of market demand also allows us to estimate own-price elasticity and consumer surplus for golden rice. Comparing willingness-to-pay (WTP) estimates from the OECE with those from a uniform-price auction, we find that OECE WTP estimates exhibit less affiliation across rounds, and the effects of positive and negative information under the OECE are more consistent with prior expectations and existing studies. We also find that while auction WTP estimates more than double across five rounds, OECE WTP estimates are stable across rounds and are always roughly equal to those from the final auction round.choice experiments, experimental auctions, golden rice, valuation

PMP22 exon 4 deletion causes ER retention of PMP22 and a gain-of-function allele in CMT1E

OBJECTIVE: To determine whether predicted fork stalling and template switching (FoSTeS) during mitosis deletes exon 4 in peripheral myelin protein 22 KD (PMP22) and causes gain‐of‐function mutation associated with peripheral neuropathy in a family with Charcot–Marie–Tooth disease type 1E. METHODS: Two siblings previously reported to have genomic rearrangements predicted to involve exon 4 of PMP22 were evaluated clinically and by electrophysiology. Skin biopsies from the proband were studied by RT‐PCR to determine the effects of the exon 4 rearrangements on exon 4 mRNA expression in myelinating Schwann cells. Transient transfection studies with wild‐type and mutant PMP22 were performed in Cos7 and RT4 cells to determine the fate of the resultant mutant protein. RESULTS: Both affected siblings had a sensorimotor dysmyelinating neuropathy with severely slow nerve conduction velocities (<10 m/sec). RT‐PCR studies of Schwann cell RNA from one of the siblings demonstrated a complete in‐frame deletion of PMP22 exon 4 (PMP22Δ4). Transfection studies demonstrated that PMP22Δ4 protein is retained within the endoplasmic reticulum and not transported to the plasma membrane. CONCLUSIONS: Our results confirm that that FoSTeS‐mediated genomic rearrangement produced a deletion of exon 4 of PMP22, resulting in expression of both PMP22 mRNA and protein lacking this sequence. In addition, we provide experimental evidence for endoplasmic reticulum retention of the mutant protein suggesting a gain‐of‐function mutational mechanism consistent with the observed CMT1E in this family. PMP22Δ4 is another example of a mutated myelin protein that is misfolded and contributes to the pathogenesis of the neuropathy

Assessing the Stroke-Specific Quality of Life for Outcome Measurement in Stroke Rehabilitation: Minimal Detectable Change and Clinically Important Difference

<p>Abstract</p> <p>Background</p> <p>This study was conducted to establish the minimal detectable change (MDC) and clinically important differences (CIDs) of the physical category of the Stroke-Specific Quality of Life Scale in patients with stroke.</p> <p>Methods</p> <p>MDC and CIDs scores were calculated from the data of 74 participants enrolled in randomized controlled trials investigating the effects of two rehabilitation programs in patients with stroke. These participants received treatments for 3 weeks and underwent clinical assessment before and after treatment. To obtain test-retest reliability for calculating MDC, another 25 patients with chronic stroke were recruited. The MDC was calculated from the standard error of measurement (SEM) to indicate a real change with 95% confidence for individual patients (MDC₉₅). Distribution-based and anchor-based methods were adopted to triangulate the ranges of minimal CIDs. The percentage of scale width was calculated by dividing the MDC and CIDs by the total score range of each physical category. The percentage of patients exceeding MDC₉₅and minimal CIDs was also reported.</p> <p>Results</p> <p>The MDC₉₅of the mobility, self-care, and upper extremity (UE) function subscales were 5.9, 4.0, and 5.3 respectively. The minimal CID ranges for these 3 subscales were 1.5 to 2.4, 1.2 to 1.9, and 1.2 to 1.8. The percentage of patients exceeding MDC₉₅and minimal CIDs of the mobility, self-care, and UE function subscales were 9.5% to 28.4%, 6.8% to 28.4%, and 12.2% to 33.8%, respectively.</p> <p>Conclusions</p> <p>The change score of an individual patient has to reach 5.9, 4.0, and 5.3 on the 3 subscales to indicate a true change. The mean change scores of a group of patients with stroke on these subscales should reach the lower bound of CID ranges of 1.5 (6.3% scale width), 1.2 (6.0% scale width), and 1.2 (6.0% scale width) to be regarded as clinically important change. This information may facilitate interpretations of patient-reported outcomes after stroke rehabilitation. Future research is warranted to validate these findings.</p

Atmospheric Circulation Response to an Instantaneous Doubling of Carbon Dioxide. Part II: Atmospheric Transient Adjustment and Its Dynamics

The dynamical mechanisms underlying the transient circulation adjustment in the extratropical atmosphere after the instantaneous doubling of carbon dioxide are investigated using the National Center for Atmospheric Research Community Atmosphere Model version 3 coupled to a Slab Ocean Model. It is shown that the transient process during the first few months of integration is important in setting up the extratropical circulation response in equilibrium such as the poleward shift of the tropospheric jet streams. Three phases are found during the transient thermal/dynamical adjustment in the Northern Hemisphere: 1) a radiatively driven easterly anomaly in the subpolar stratosphere, 2) an acceleration of the westerly anomaly in the subpolar stratosphere as a result of anomalous planetary-scale eddy momentum flux convergence, and 3) a “downward migration” of the westerly anomaly from the lower stratosphere to the troposphere, followed by the tropospheric jet shift. Several proposed mechanisms for inducing the poleward shift of the tropospheric jet streams are examined. No significant increase in eddy phase speed is found. The rise in tropopause height appears to lead the tropospheric jet shift but no close relation is observed. The length scale of transient eddies does increase but does not lead the tropospheric jet shift. Finally, the tropospheric jet shift can be captured by changes in the index of refraction and the resulting anomalous eddy propagation in the troposphere

Atmospheric Circulation Response to an Instantaneous Doubling of Carbon Dioxide Part I: Model Experiments and Transient Thermal Response in the Troposphere

This study aims to understand the dynamical mechanisms driving the changes in the general circulation of the atmosphere due to increased carbon dioxide (CO2) by looking into the transient step-by-step adjustment of the circulation. The transient atmospheric adjustment is examined using the National Center for Atmospheric Research Community Atmospheric Model Version 3 coupled to a slab ocean model and the CO2 concentration in the atmosphere is uniformly and instantaneously doubled. The thermal structure and circulation response is well established after one year of integration with the magnitudes gradually increasing afterwards towards quasi-equilibrium. Tropical upper tropospheric warming occurs in the first month. The expansion of the warming in the middle and upper troposphere to the subtropics occurs later and is found to be primarily dynamically-driven due to the intensification of transient eddy momentum flux convergence and resulting anomalous descending motion in this region. The poleward displacement of the midlatitude tropospheric jet streams occurs together with the change in eddy momentum flux convergence but only after the intensification of the subpolar westerlies in the stratosphere. The results demonstrate the importance of the tropospheric eddies in setting up the extratropical tropospheric response to global warming

SegICP: Integrated Deep Semantic Segmentation and Pose Estimation

Recent robotic manipulation competitions have highlighted that sophisticated robots still struggle to achieve fast and reliable perception of task-relevant objects in complex, realistic scenarios. To improve these systems' perceptive speed and robustness, we present SegICP, a novel integrated solution to object recognition and pose estimation. SegICP couples convolutional neural networks and multi-hypothesis point cloud registration to achieve both robust pixel-wise semantic segmentation as well as accurate and real-time 6-DOF pose estimation for relevant objects. Our architecture achieves 1cm position error and <5^\circ$ angle error in real time without an initial seed. We evaluate and benchmark SegICP against an annotated dataset generated by motion capture.Comment: IROS camera-read

Assessing Equity and Environmental Justice in the Great Lakes Restoration Initiative

Since its inception in 2010, the Great Lakes Restoration Initiative (GLRI) program has completed more than 5,300 restoration projects across the larger Great Lakes region, representing a ~$2.7 billion federal investment. This bipartisan federal effort annually appropriates$300 million across the GLRI’s five main focus areas, with one-third of this investment supporting the 43 most polluted sites in the Great Lakes basin—those identified through the Area of Concern (AOC) program back in the 1970s. In the last decade, the GLRI program has demonstrated significant ecological and economic successes, with much progress being made towards delisting AOCs. Despite these environmental and economic successes, there is little documented evaluation of whether the GLRI program has served to minimize environmental risk and remediate legacies of environmental inequities. Few studies have examined social equity within the GLRI program, even though the initiative was formed to accelerate the restoration of the Great Lakes ecosystem and ensure a sustainable water-based future for the region. Groups like the Healing Our Waters—Great Lakes (HOW) Coalition, who work to educate members of Congress and the public about the far-reaching benefits of GLRI funding, have begun investigating how the program both considers and impacts social equity in its restoration work throughout the region. Specifically, HOW is interested in learning about how federal GLRI investments can be best implemented so that the benefits of restoration reach the full spectrum of Great Lakes socio-economic groups in an equitable manner. We began this inquiry into emphasizing social equity across the GLRI. We aimed to illustrate how equity considerations need to play a critical role in the ongoing revitalization of the Great Lakes region and provided recommendations for ways HOW can advocate for equitybased policy and administrative considerations within the GLRI program. Our recommendations stemmed from case studies of four different AOCs in Michigan: White Lake, Muskegon Lake, the Rouge and Detroit rivers, and the River Raisin. Semi-structured participatory interview methods were used to build a clearer understanding of how communities have been impacted by their impaired freshwater resources, and how they perceive equity outcomes and considerations in current and past restoration efforts. In addition, ArcGIS geo-visualization software was used to map the distribution of GLRI restoration projects with social demographics for each study AOC community in order to illustrate social equity patterns and disparities and supplement community interview insights. Our recommendations delineate actions the HOW Coalition can pursue with community organizations across the Great Lakes region, and equity considerations that HOW can advocate for at the federal level. Recommendations for HOW’s federal advocacy work are further broken down into congressional policy recommendations and EPA program administration recommendations.Master of ScienceSchool for Environment and SustainabilityUniversity of Michiganhttp://deepblue.lib.umich.edu/bitstream/2027.42/167296/1/EquityInGLRI_375_Project.pd

Inhibiting Lox-1 Receptor in Macrophages in Atherosclerosis

Gemstone Team CORCardiovascular disease is the leading cause of death in the United States. During the process of plaque development called atherosclerosis, oxidized low-density lipoproteins (oxLDL) penetrate the endothelial lining of the arterial wall. The damage to the endothelial wall induces a signaling pathway to trigger an inflammatory response. Monocytes then phagocytose oxLDL in an attempt to prevent damage to the endothelial wall and ultimately transform into foam cells that constitute plaque tissue. This study explores the prevention of arterial plaque buildup in atherosclerosis using miRNA let-7g. Through bioinformatics, lectin-type oxidized LDL receptor (LOX-1), a macrophage scavenger receptor protein that uptakes oxLDL, leading to foam cell formation, was identified as a potential target. After a thorough literature review, miRNA let-7g was found to be the most promising miRNA that inhibits LOX-1 expression. By preventing the expression of LOX-1, the macrophage will no longer respond to oxLDL signaling and ultimately inhibit plaque development. Our aim was to determine if LOX-1 expression in macrophages would increase in a dose dependent manner in response to increased oxLDL concentrations. LOX-1 expression in human macrophage primary cell cultures was measured using a flow cytometry assay. We found that oxLDL concentration was not correlated with macrophages’ expression of LOX-1 receptor in a dose-dependent manner. This suggests that inflammatory signaling molecules are needed for LOX-1 upregulation and increased oxLDL uptake. It is expected that using let-7g in conjunction with an anti-inflammatory compound, such as rapamycin, will further inhibit oxLDL uptake by macrophages and result in a novel treatment for atherosclerosis